Creative Motion Alliance, Inc
Application for Extension for Certification Time Period
Level II & III only
(Appendix K)

To apply you may complete the online form below, or download and complete the application form and mail to chair of the Certification Committee.


Date :

NAME
Salutation: Mr. - - Mrs. - - Ms. - - Dr.
First : Last:
Address and Contact Info
Mailing Address - Street Address:
City / Town : State / Province : Zip
Phone:
Other Phone:
E-mail 1:
E-mail 2:


Certification in progress: Level II - - - or - - - Level III


Describe the circumstances that require an extension of the Certification time period.



If you wish to retain a copy of this form for your own records, please print this prior to pressing the Submit button.

This application will be reviewed by the Creative Motion Alliance's Certification Committee.
You will be informed of the committee's decision in a timely manner.